Snoring surgery involves surgical manipulations of the throat or nasal cavity for the treatment of sleep apnea and obstructive sleep apnea syndrome. Before we look at the types of surgeries, let’s first get an understanding of the syndromes…
Sleep Apnea and Obstructive Sleep Apnea Syndrome
Sleep apnea is a condition where a person stops breathing for a short period of time (10 seconds or more) when sleeping. During sleep, the muscles of the pharynx relax and create a narrowing of the upper airways, so much so that the sleeper struggles to breath. The lack of oxygen entering the lungs reduces the blood oxygen saturation in the body. When the body identifies this, it sends a signal to the brain to stimulate a brief awakening, which is usually not remembered by the sleeper the next day but is enough to expand the airways to normalise blood oxygen levels. After the sleep apnea episode, there is a loud breath.
Obstructive sleep apnea syndrome happens when cycles of sleep apnea episodes repeat throughout the night. If you add up all the episodes of sleep apnea during one night it would be the same as if a person is not breathing for several hours per day!
Effective traditional treatment is the use of a positive air pressure device- CPAP machine at night. Treatment with this method has good results, but is only used by 50% of patients due to their cumbersome nature. There are other methods of treating obstructive sleep apnea syndrome, and one of them is surgery. Snoring surgery should never be performed without a prior sleep study. This is a last-resort treatment and should only be considered if the conservative non-surgical alternatives have tried and failed.
Procedures and Types of Snoring Surgery
Surgical methods of treatment for obstructive sleep apnea syndrome are divided into two phases of surgical interventions. The decision to perform surgery on the first or second surgical phase is based on the location and extent of the obstruction. The most important part is to establish a diagnosis, determine the site of obstruction, and then choose a method of treatment. To understand the severity, doctors perform lateral cephalometry (an xray taken of the side of the face), endoscopy, X-ray, CT, and MRI. As with any surgery, an effective outcome depends on a good initial examination.
Phase one of surgical operations are performed for mild forms of obstructive sleep apnea and investigates if there are structural abnormalities that need to be corrected, for example if there is an underdeveloped lower or upper jaw. The success of this surgical treatment is about 70 percent.
If the first phase doesn’t achieve a desired result, the second phase of treatment is orthognathic surgery on both jaws (major surgery to correct skeletal and dental irregularities). The success rate of these operations is up to 96-100% in patients with structural abnormalities.
There are other methods used in addition to the traditional surgical procedures: ultrasound, laser and radio wave uvulopalatoplasty (the formation of a “new” soft palate) and uvulopalatopharyngoplasty (resection of the soft palate, palatine uvula and hypertrophied tonsils).
Types of Surgery
Classic Surgery
During Classic Surgery, anesthesia is administered and there is removal of excess soft tissues of the pharynx with a scalpel. Due to the painful and invasive nature of this method, is not used often, as there are now advanced methods to surgically correct snoring.
Laser-Assisted Uvulopalatoplasty
This is the burning of hypertrophied tissues with the help of a laser beam. This method is also invasive, as it causes burn tissues, but is a more effective method than the classic surgery.
However, experts from the American Academy of Sleep Medicine state that: “The uvulopalatoplasty does not solve the problem of obstructive apnea since it does not normalize the apnea index (the number of sleep apnea per one hour of sleep) and a number of other objective parameters. Since there is no significant improvement after the operation and there is a risk of developing a pain syndrome and postoperative complications, a procedure is not recommended for patients with obstructive sleep apnea”.
Uvulotomy
This is uvula surgery for sleep apnea and involves the removal of the uvula. It is a simple operation, recommended for an enlarged or deformed uvula due to benign tumors, which are usually papillomas.
Radio-wave Somnoplasty
This is the “golden standard” for the treatment of obstructive sleep apnea syndrome and snoring in modern surgery. It is a surgical method that destroys soft palate tissue in the submucosal layer through an electrode. This technique reduces the surface of the wound, significantly reducing the pain in the postoperative period and accelerating the process of regeneration of the mucous membrane.
The patient will not feel pain at the time of the operation, however the next day there is usually a slight discomfort when swallowing. In the postoperative period is usually 5-7 days and it takes 10-12 days to heal completely.
Septoplasty
The above-mentioned operations are often complemented by nasal restoration surgery called Septoplasty. This surgery eliminates existing issues of breathing associated with nasal septum deviation. Restoring the nasal septum’s anatomically correct structure decreases the severity of snoring.
Other methods of surgical treatment of sleep apnea syndrome include:
- Plastic surgery on the mandible to change the shape of the lower jaw.
- Other nasal surgical interventions, such as turbinectomy (surgical operation consisting in removing some or all of the turbinate bones in the nasal passage, generally to relieve nasal obstruction)
- Surgical treatment of obesity.
The Riley-Powell-Stanford step-by-step protocol known as Uvulopalatopharyngoplasty has effective results in curbing snoring surgery in patients with sleep apnea, but additional data from controlled clinical trials are required for more accurate evaluation.
The postoperative period can be long, depending on the type of surgery. In this period, a patient is placed on a strict diet, with limited physical activity and prohibited from the pool and sauna. If required, the patient will be encouraged to decrease excess body weight as this will improve the effectiveness of the surgery and reduce the risk of recurrence.
Snoring Surgery Side Effects
Possible postoperative complications include:
- Severe pain;
- Pharyngostenosis- narrowing of the pharynx caused by cicatricial deformation of the pharyngeal tissues;
- Loss of the closing function of the soft palate;
- Change of voice;
- Only a minor improvement to initial issue;
- Postoperative wound infection;
- Bleeding;
- Some patients in the postoperative period require a tracheostomy or a CPAP machine for safe breathing.
All surgical procedures should only be performed if the cause of the snoring or sleep apnea is due to abnormalities in the anatomical tissues. There are numerous causes of obstructive sleep apnea and only some are related to the deformities of soft palate tissues. The operation will be useless and sometimes even harmful if there is no doctors’ diagnosis that the soft tissues of the palate are deformed and that is the cause of the snoring.
Lastly and importantly, all operated patients should do a polysomnography (sleep study) to accurately evaluate the effectiveness of the treatment.
